209 -Culturally Responsive Services for African Americans

Culturally responsive Service with African American Clients Objectives

~ African Americans or Blacks are people whose origins are “in any of the black racial groups of Africa” ~ The term includes ~ Descendants of African slaves brought to this country against their will ~ More recent immigrants from Africa, the Caribbean, and South or Central America ~ many individuals from these latter regions, if they come from Spanish-speaking cultural groups, identify primarily as Latino Treatment Issues/Barriers ~ African Americans are less likely than White Americans to receive treatment for anxiety and mood disorders ~ African Americans are more likely to be diagnosed with schizophrenia and less likely to be diagnosed with affective disorders than White Americans, even though multiple studies have found that rates of both disorders among these populations are comparable ~ African Americans are about twice as likely to be diagnosed with a psychotic disorder as White Americans and more than three times as likely to be hospitalized for such disorders. ~ For an overview of mental health across populations, refer to Mental Health United States, 2010 (SAMHSA 2012a). Treatment Issues ~ Blacks were much more likely to receive mental health services from general practitioners than from mental health specialists (Outreach) ~ Were significantly more likely than White Americans to have an undetected co-occurring mental disorder, and, if detected, they were significantly less likely than White Americans or Latinos to receive treatment for that disorder ~ African Americans are more likely to be referred to treatment from criminal justice settings rather than self-referred or referred by other sources Treatment Issues/Barriers ~ Lack of familiarity with the value and use of specialized behavioral health services may limit service use. ~ An essential step in decreasing disparity in behavioral health services among African Americans involves using culturally sensitive instruments and evaluation tools ~ African Americans were more likely than members of other major ethnic/racial groups to state that they lacked transportation to the program or that their insurance did not cover the cost of such treatment ~ Longstanding suspicions regarding established healthcare institutions can also affect African Americans' participation in, attitudes toward, and outcomes after treatment Treatment Issues/Barriers ~ Attitudes toward psychological services appear to become more negative as psychological distress increases (Early intervention) ~ In many African American communities, there is a persistent belief that social and treatment services try to impose White American values ~ African Americans, even when receiving the same amount of services as White Americans, are less likely to be satisfied with those services

Approaches ~ African American clients generally respond better to an egalitarian and authentic relationship with counselors ~ Request personal information gradually rather than attempting to gain information as quickly as possible ~ Avoid information-gathering methods that clients could perceive as an interrogation ~ Be willing to validate African American clients' experiences of racism and its reality in their lives ~ Racism and discrimination can lead to feelings of anger, anxiety, or depression. ~ These feelings are pervasive ~ Counselors should explore with clients the psychological effects of racism and develop approaches to challenge internal negative messages that have been received or generated 6 Core Principles ~ Discussion of clients' issues should be framed in a context that recognizes the totality of life experiences faced by clients as African Americans. ~ Equality is sought in the therapeutic counselor–client relationship, and counselors are less distant and more disclosing. ~ Emphasis is placed on the importance of changing one's environment for the client and the greater good of their communities. ~ Focus is placed on coping strategies and solutions that underscore personal rituals, cultural traditions, and spiritual well-being. ~ Recovery is a process that involves gaining power in the forms of knowledge, spiritual insight, and community health. ~ Recovery is framed within a broader context of how recovery contributes to the overall healing and advancement of the African American community.

Interventions ~ Interventions should make use of the core African American value of communalism by addressing the ways in which the individual's substance abuse affects his or her whole community. ~ African American music, artwork, and food can help programs create a welcoming and familiar atmosphere ~ Node-link mapping is a recommended practice (visual representation using information diagrams, fill-in-the-blank graphic tools, and client-generated diagrams or visual maps). Interventions ~ Cognitive–behavioral therapy (CBT) advantages ~ Fosters a collaborative relationship ~ Recognizes that clients are experts on their own problems ~ Compared to 12-Step facilitation CBT achieved better outcomes ~ Trauma Affect Regulation: Guide for Education and Therapy (TARGET) is an educational and psychotherapeutic intervention for adults and families designed to prevent and treat traumatic stress, and affective and adjustment disorders related to other types of stressors (like discrimination/racism). ~ Accelerated Resolution Therapy is a brief, exposure-based psychotherapy to treat trauma, depression, and anxiety. The program is delivered over 2 weeks. Interventions ~ Depression Prevention (Managing Your Mood) ~ Is a computer-tailored intervention (CTI) for adults ~ Goal is to help individuals take proactive steps to recognize, manage, and reduce depression symptoms and to prevent the onset of major depression. ~ A review of cultural adaptations of evidence-based practices is given by Bernal and Domenech Rodriguez (2012) Strengths of African American Family Life ~ Strong bonds and extensive kinship. ~ Adaptability of family roles. ~ A strong family hierarchy. ~ A strong work orientation. ~ A high achievement orientation. ~ A strong religious orientation.

Family Therapy ~ African American clients appear more likely to stay connected with their families throughout the course of their illness. ~ African American families are embedded in a complex kinship network of biologically related and unrelated persons. ~ Clients need to be asked how they define family, whom they would identify as family or “like family,” who resides with them in their homes, and whom they rely on for help and incorporate those people in the process (with permission) Family Therapy ~ Engaging Moms is family-oriented program and intervention developed specifically for African American mothers that has been shown to significantly improve treatment engagement ~ The six core areas of change include: ~ Mother’s motivation and commitment to succeed in drug court and to change her life ~ The emotional attachment between the mother and her children ~ Relationships between the mother and her family of origin ~ Parenting skills ~ Mother’s romantic relationships ~ Emotional regulation, problem solving, and communication skills Family Therapy ~ Multisystem family therapy approach incorporates an extended network of relationships that play a part in clients' lives including social service and other community agencies can be considered a significant part of the family system. ~ MST recognizes that each system plays a critical role in a youth's (12-17)world and each system requires attention when effective change is needed to improve the quality of life for youth and their families. ~ They work intensively with parents and caregivers to put them in control, helping them keep the adolescent focused on school and gaining job skills, and introduce the youth to sports and recreational activities as an alternative to hanging out Family Therapy ~ Network therapy, which involves clients' extended social networks, has also been found to improve outcomes for African American clients when added to standard treatment ~ The family team conference model can be a useful approach, given that it also engages both families and communities in the helping process by attempting to stimulate extensive mobilization of activity in the formal and informal relationships in and around clients' families Group Therapy ~ Because of the communal, cooperative values held by many African Americans, group therapy is effective ~ Speaking in groups is generally acceptable to African American clients. ~ Note that Black Caribbean Americans can be less comfortable with self-disclosing personal problems to strangers. ~ African Americans seem less likely to self-disclose about the past in group settings that include non-Hispanic Whites ~ Homogenous African American groups can be good venues for clients to deal with systemic problems, such as racism and lack of economic opportunities in the African American community Mutual Help/Support Groups ~ The Black community has changed the mutual-help model for substance use and mental health to make it more empowering and relevant to African American participants. ~ For additional information on the 12 Steps for African Americans, visit Alcoholics Anonymous World Services (AAWS), AA for the Black and African American Alcoholic, available online (http://www.aa.org/pdf/products/p-51_CanAAHelpMeToo.pdf). Values and Attitudes ~ African American culture and history is steeped in healing traditions passed down through generations, including herbal remedies, root medicines, and so forth ~ They also use modern therapeutic approaches or other alternative approaches. ~ They accept and use all forms of treatment selectively, depending on the perceived nature of their health problems. ~ Psychological and substance abuse problems can be seen as having spiritual causes that need to be addressed by traditional healers or religious practices Values and Attitudes ~ African Americans are much more likely to use religion or spirituality as a response to physical or psychological problems ~ African American cultural and religious institutions play an important role in treatment and recovery, education, politics, recreation, and social welfare in African American communities. ~ A growing number of African Americans are converts to Islam, and many recent immigrants from Africa to the United States are also Muslims Values and Attitudes ~ It is common for African Americans to approach clergy first with mental health problems, but many clergy members do not feel prepared to address those problems ~ Opportunity for outreach and education and to facilitate referrals ~ Consider involving African American clergy in treatment programs to improve better engage clients/families. ~ Other means of engagement within the church can lead to recovery. ~ Participation in religious services ~ Use of peer mentors Culturally Responsive Group Education ~ A common misconception about culturally responsive instruction is that facilitators must teach the “Asian way” or the “black way.” ~ People often get intimidated by the words culturally responsive because of the incredible number of cultures and mixes of cultures in today's treatment groups. ~ Too often, clinicians subscribe to the misguided idea that clients of different races need to be taught differently ~ For example, you may incorporate popular music into sessions because many of the participants relate to music ~ You don't have to be African American, Latino, or from any particular cultural background to listen to a specific type of music Culturally Responsive Group Education ~ When you teach complicated concepts, make analogies or use metaphors about cars, animals, sports, or other topics that will pique participant interest. ~ Teach the entire concept in a way that all of your participants can relate to and understand, using aspects of their cultures with which you are comfortable. ~ Mindfulness ~ Meditation ~ Vulnerability Prevention ~ CBT ~ Boundaries… ~ Teach to their collective culture

Keys to Responsive Psychoeducation ~ Know the Learner: ~ Learning styles and pace ~ Personal qualities such as personality, temperament and motivation, personal interests ~ Other influences to learning including health, family circumstances, and language preference.

Keys to Responsive Psychoed. Cont… ~ A Quality Facilitator ~ Believes all participants can learn ~ Has the desire and capacity to differentiate curriculum and instruction ~ Understands diversity and thinks about participants developmentally ~ Quality Curriculum needs to be ~ Interesting to participants and relevant to their lives ~ Thought provoking ~ Focused on concepts and principles and not just facts ~ Stress depth of learning, not just coverage. Keys to Responsive Psychoeducation ~ Flexible Teaching and Learning Time Resources: ~ Team work ~ Block scheduling ~ Homework ~ Auditory, visual, kinesthetic resources presented for the active and reflective learner ~ Instructional Delivery and Best Practices: ~ Cooperative learning ~ Learning stations and centers ~ Individual treatment plans and goals tied to groups ~ Literature/learning circles. Keys to Responsive Psychoeducation ~ Assessment &Evaluation includes o ~ Observations ~ Skills checklists ~ Demonstrations ~ Semistructured interviews ~ Standardized tests or pre/post tests Keys to Responsive and Engaging Psychoed. ~ Communication of High Expectations − Belief that participants will succeed, based upon genuine respect for participants and belief in student capability. ~ Active Teaching Methods promote participant engagement by requiring them to play an active role in crafting curriculum and developing learning activities. ~ Student−Controlled Classroom Discourse allows participants to control some portion of the lesson, providing facilitators with insight into the ways that speech and negotiation are used in the home and community. ~ Leader as Facilitator serving as guide, mediator, and knowledgeable consultant, as well as instructor. ~ Cultural Sensitivity through knowledge of the cultures represented in their classrooms and translate this knowledge into instructional practice.

Keys to Responsive and Engaging Psychoed. ~ Positive Perspectives Cultural Diversity ~ There is an ongoing dialogue with participants and community members on issues important to them, along with the inclusion of these individuals and issues in group/program activities. ~ Lobby contains reading materials about families and children from different walks of life. ~ Therapist/facilitator maintains frequent communication with family members. ~ Facilitator attempts to relate all stories to the personal lives of the participants. ~ Concepts are linked to learning about families, backgrounds, and cultures. Culturally Responsive Outreach and Psychoed ~ Gamification: Most games employ a lot of the cultural tools you’d find in oral traditions – repetition, solving a puzzle, making connections between things that don’t seem to be related. ~ Jeopardy ~ Taboo ~ Create a game ~ Lottery ~ Group or individual winning at games or accomplishing a task can earn points to be used in a token economy Culturally Responsive Outreach and Psychoed ~ Make it Social Organizing learning so that participants rely on each other will build on diverse participants’ communal orientation. ~ This communal orientation can be summed up in the African proverb, “I am because we are.” ~ Even making learning slightly competitive in a good-natured way increases participants’ level of attention and engagement. ~ “How can we work together to solve this problem or prevent it in our children?” Culturally Responsive Outreach and Psychoed ~ Storify it The brain is wired to remember stories and to use the story structure to make sense of the world. ~ Diverse participants learn content more effectively if they can create a coherent narrative about the topic or process presented. That’s the brain’s way of weaving it all together. ~ Have them create skits or role plays ~ In outreach break them into similar groups (i.e. parents, pastors) ~ Have them relate it to something they already know (i.e. the Bible, Quran, a piece of literature or a current event) Summary

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